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Full text of "United States Navy Medical News Letter Vol. 27, No. 7, 6 April 1956"

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NavMed 369 

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UNITED STATES NAVY E 

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Editor - Captain L. B. Marshall, MC, USN (RET) 



Vol. Zl Friday, 6 April 1956 No. 7 



TABLE OF CONTENTS 

Operation Deep Freeze 2 

Residency Training in Allergy 2 

Naval School of Hospital Administration • • • • 3 

Grow the Green Grass Here 5 

Hodgkin's Disease 11 

Aldosterone in Clinical Medicine 14 

Listeria Meningitis 16 

Roentgenologic Diagnosis of Ruptured Spleen 18 

Metastatic Pulmonary Malignancy 20 

Monograph on Frostbite, Reference to , 21 

Standard First Aid Training Course 21 

From the Note Book 22 

Board Certifications 23 

Ejection Seat Trainers (BuMed Inst. 6410. lA) 25 

Fiscal Services Work Measurement Program (BuMed Notice 5202) 25 

DENTAL SECTION 

Dr. Harry Lyons Appointed Honorary Civilian Consultant 26 

Dental Personnel Briefs ; ' .\ ... 26 

Reserve Dental Officers Selected for Promotion to Captain 26 

"The Most Traveled Man" 28 

Dental School Staff Member to Receive Alumni Award 28 

MEDICAL RESERVE SECTION 

Reservists' Training When Apart from Regular Units 29 

New Medical Department Correspondence Course 29 

Officers' Pay Status in Non-Pay Drilling Units 30 

PREVENTIVE MEDICINE SECTION 

Distribution of Polio Vaccine 31 

Carbon Monoxide from Gasoline Powered Industrial Equipment _ _ 37 

Refrigeration of Leftover Foods 38 

Special Assistant for Sanitation - District Public Works Offices 39 

Two -Months Course in Occupational Medicine 40 




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Medical News Letter, Vol. 27, No. 7 



Policy 

The U. S. Navy Medical News Letter is basically an official Medical 
Department publication inviting the attention of officers of the Medical Depart- 
ment of the Regular Navy and Naval Reserve to timely up-to-date items of 
official and professional interest relative to medicine, dentistry, and allied 
sciences. The amount of information used is only that necessary to inform 
adequately officers of the Medical Department of the existence and source 
of such information. The items used are neither intended to be nor are they 
susceptible to use by any officer as a substitute for any item or article in 
its original form. All readers of the News Letter are urged to obtain the 
original of those items of particular interest to the individual. 

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Notice 



Due to the critical shortage of medical officers, the Chief, Bureau 
of Medicine and Surgery, has recommended, and the Chief of Naval Personnel 
has concurred, that Reserve Medical Officers now on active duty who desire 
to submit requests for extension of active duty at their present stations for 
a- period of three months or more will be given favorable consideration. 
BuPers Instruction 1926, IB applies. 

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Operation Deep Freeze 

Medical officer volunteers are urgently desired for operation Deep 
Freeze II. Must have 24 months' obligated service or agree to extend. 
Details outlined in AlNav-4, 1956. 

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Residency Training in Allergy 

There will be a space available for a resident in Allergy.at the U.S. 
Naval Hospital, San Diego, Calif. , beginning April 1956. Applications are 
invited from Regular officers and Reserves who have completed their obliga- 
ted service. Prior training in Internal Medicine of one or more years is a 
prerequisite. (ProfDiv, BuMed) 



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Medical News Letter, Vol. 27, No. 7 



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Naval Scho ol of Hospital Administration 

The U.S. Naval School of Hospital Administration, primarily a naval 
training school for officers of the Medical Service Corps and Hospital Corps, 
has functioned at the National Naval Medical Center, Bethesda, Md. , since 
mid 1942. 

In 1946, the school's function was expanded to include courses for 
enlisted hospital corps personnel. The added courses included clerical, 
property and accounting, and commissary procedures. In 1948, these 
courses were consolidated into one curriculum leading to certification as 
Medical Administrative Technician. 

The authorized number of students currently attending the school 
is 40 officers and 100 enlisted personnel. This is the maximum number 
of students the School's facilities will accommodate. 

The School was established on 3 August 1942 as a Training Depart- 
ment of the U.S. Naval Hospital, National Naval Medical Center. On 12 July 
1943, the School was officially designated as the Hospital Corps Officers 
School under the command of the Commanding Officer, U.S. Naval Hospital, 
with a Hospital Corps Officer as Officer in Charge. On 2 August 1945, the 
School was established as a separate commajad of the Medical Center and 
was designated as the U.S. Naval School of Hospital Administration with a 
Medical Service Corps officer as Officer in Charge, Later, this title was 
changed to the present designation. Commanding Officer. The School was 
moved to its present location. Building 141, in January 1946. The Naval 
School of Hospital Administration is a tenant command under the National 
Naval Medical Center and receives logistic support from the Center and the 
other various component commands. 

At first, the School was restricted to officer students. The course 
of instruction was limited to 6 months and was designed to embrace technical 
areas of finance, personnel, and food-service management. Since then, the 
course has been extended to approximately 10 months and the curriculum 
broadened to include the specifics for all administrative divisions of a naval 
hospital. To increase the effectiveness of the specifics, basic courses in 
English, Effective Speaking, Business Mathematics, Personnel Management, 
Accounting, and Fundamentals of Instruction have been included. 

The graduates of the School, sixteen classes, represent a total of 
696 officers. Included among the graduates are 40 officers from other 
Services: 9 U S. Army, 28 U.S. Air Force, 1 Ecuador Navy, I South 
Korea Navy, and I Chinese Nationalist Navy. 

A separate course for enlisted personnel was started in July 1948. 
The course has been developed to cover all areas of medical administrative 
procedures. Graduates are designated as Medical Administrative Techni- 
cians upon the completion of approximately 10 months of training. To date, 
a total of 969 technicians have been graduated. 



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Medical News Letter, Vol, 27, No. 7 



The administrative offices, library, auditorium, publications, 
training -aids library, and six classrooms are located in Buildings 141 and 
142. 

The School library, under the immediate supervision of a civilian 
Library Assistant, is a branch of the Edward Rhodes Stitt Library of the 
National Naval Medical Center. The School library contains approximately 
3800 selected volumes which provide a ready reference in the fields of hos- 
pital administration, education, and training. Through the facilities of the 
Stitt Library, an additional 35,000 books, journals, and pamphlets are made 
available to staff and student personnel. 

The aim of the School is to provide the motivation and opportunity 
for officers of the Medical Service and Hospital Corps to develop under- 
standings, abilities, and skills which will constitute a foundation for the 
officer's self -development and which will serve as a basis for the officer's 
growth in the administrative field. This being a Service school, emphasis 
is necessarily directed at technical areas that are specifics for the various 
administrative divisions in a governmental -military hospital — specifically 
a naval hospital. Within this naval framework, the curriculum and the 
methods of instruction have been designed for the development of transfer- 
able skills, resourcefulness, and analytical capacity. The simple acquisi- 
tion of the knowledge of highly specialized and transitory facts or techniques 
has been minimized. 

The objectives for each unit of the curriculum are developed from 
the major aim, and an emphasized corollary to this aim is the development 
of an appreciation and an understanding of the human relations aspects in- 
volved in administrative action in any endeavor. 

Although the abilities and understandings required for a competent 
administrator cannot be attained in 10 months, the course does impart a 
knowledge of the facts and techniques for the effective supervision of the 
various administrative divisions of a naval hospital. With the achievement 
of the objectives in the school's program, the student is given an effective 
start in his acquisition of these abilities and understandings. 

To augment the course of instruction at the School, other govern- 
mental and civilian facilities are utilized in the training program. Field 
trips, in addition to the various facilities of the Naval Medical Center, 
are made to the National Institutes of Health, a number of food-service 
facilities, a meat-packing facility, sewage disposal and water treatment 
plants, a dairy and milk plant, and a produce market. 

In view of the periodic rotation of military instructors, the academic 
backgrounds of the military staff vary slightly from year to year. However, 
through the increased utilization of the instructors from the teaching staffs 
of local universities, through the increased employment of prominent civ- 
ilian lecturers, and through the selective assignment of staff military per- 
sonnel, the status of the faculty has been greatly improved. 



Medical News Letter, Vol. 27, No. 7 



5 



Four courses are taught exclusively by civilian instructors from 
local universities. Civilian lecturers, specialists in their fields, are em- 
ployed on a part-time basis. Military specialists from the Navy Department 
and civilian specialists from other agencies provide lecture service in their 
specialties. 

In the Hospital Administration Course, there are 1323 classroom 
hours, practical and didactic, covering a period of approximately 9-1/2 
months. Subjects covered are: fi) Accounting, (2) Administrative Law 
and Uniform Code of Military Justice, (3) Business Mathematics, (4) Effec- 
tive Speaking, (5) English, (6) Environmental Sanitation, (7) Financial Man- 
agement, (8) Fooi Service, (9) Fundamentals of Instruction, {10) Mainte- 
nance and Safety Engineering, (11) Office Management, (12) Personnel 
Management, (13) Personnel Records and Administration, (14) Report 
Writing, ( 1 5) Security, and (1 6) Special Services. 

An indoctrination course for medical administrative officers of the 
Naval Reserve has been designed to provide ample coverage of the basic 
duties and responsibilities of the Medical Service Corps Officers in Medical 
Department organization and administration to enable them to serve effec 
tively as assistants in the various administrative divisions of a naval hos- 
pital while receiving on-the-job training. The course was offered in the 
summer of 1953, and although only 8 weeks in duration, it closely paralleled 
the course content in Hospital Administration. The framework for this pro- 
gram still exists and can be utilized in future planning. (Naval School of 
Hospital Administration, NNMC) 

Grow the Green Gras s Here 

The grass is always greener on the other side of the fence. A cliche, 
yes, but also one way of expressing the motivation behind the departure of 
alarming numbers of men from the Armed Forces. 

Civilian pastures are painted in verdant tones by talent hungry person- 
nel managers. Rising business indexes set the hearts of eager men to palpita- 
ting. Every one can make a million once he goes back to college and invests 
a little of Uncle Sam's money and his own time in self -improvement. The vista 
is so overwhelming that those who intend to stay on this side of the fence have 
everywhere adopted the defensive against the stampede to civilian life. Instead 
of selling our own yard and tearing down the fence, we have built the fence 
higher. Yet, there stand the walls of China to pay mute tribute to the folly 
of such a philosophy. Just as they were inadequate to withstand the hordes 
trying to get into China, so will all the walls built of increased pay, better 
fringe benefits, and other emoluments be inadequate to hold in the Armed 
Forces an adequate number of career officers and men if we don't try to sell 
them on the ideological and philosophical value of a military career. 



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Medical News Letter, Vol. 27, No. 7 



The problem of whether to stay in or get out is probably as old as 
the Navy. Every officer in the Navy has probably asked at some point 
whether the struggle was worthwhile. And, as many articles have said 
recently, this question is being resolved in a manner disappointing and dis- 
astrous to the military efficiency of the Defense establishment. From 1950 
to 1954, the Army reenlistment rate decreased fivefold, the Navy's decreased 
to an eighth of its previous rate, and the Marine Corps and Air Force suffered 
similarly. Thousands of words of testimony before Congressional bodies 
have belabored compensatory and other dollar benefits. The high cost of 
housing near military installations, the cost of maintaining two wardrobes, 
damage incurred to household goods, and other troubles have been described. 
We read that Communist aviators receive in cold cash buying power about 20% 
more than their American counterparts and enjoy fantastic fringe benefits. 
We are told that a civil service seaman makes twice as much as a U.S. Navy 
seaman who is married. Classified ads in newspapers seek to hire truck 
drivers, carpenters, electricians, and mechanics for $1300 and $1400 a 
month — for work overseas. Dollars are not the answer. You can't attach 
a dollar sign to the kind of responsibility a man in the military is called upon 
to shoulder. Even if you were able to, public reaction would never sanction 
legislative recognition of its true worth. The best soldiers in history have 
more often than not been underpaid, imderfed, and overworked. So the 
answer must lie elsewhere. 

Although the old adage, "You'll never grow rich in the Navy, but 
you'll never starve, " still stands, even with the latest pay raise, pay isn't 
and nev -vill be the answer. 

The question of putting to sea in ships arises. Wise men, manned 
with intelligence to aid them in calculated risks and IBM machines to balance 
commitments against availability, have done everything in their power to 
meet the need of more ships overseas and at the same time keep more men 
near their families, and more families where they want to be. Operation 
Gyroscope and the Magic Carpet runs are tributes to their efforts. But as 
long as the nation needs a Navy, the Navy is going to have to send men to sea 
and away from their families. Even this seemingly hopeless liability has 
rewards to be found and held up proudly, but no one has done it for the poor 
man questioning a career. The rejuvenative effect of a break in family routine 
is never described. The man who rides the Long Island Railroad every morn- 
ing for years and years and comes home on the same train in the afternoon, 
and his wife who goes to the same grocer and the same baker for the same 
length of time, slip into an insidious rut and frequently cease to appreciate 
each other. But, Navy families know that separations come, and consequently 
each member can see more clearly the worth of the other. Still another fac- 
tor that is never mentioned is that a man and his wife can actually come to 
know each other better while apart. We humans are an inhibited bunch and 
there are some ideas that we can't ever put across by means of the spoken 



Medical News Letter, Vol. 27, No. 7 



7 



word which slide nicely into letters. Whole new planes of mutual ideas 
can be built up in this way to provide more enjoyment when man and wife 
come together again. 

No social entity can be held together by materialistic devices alone. 
A social entity must be bonded by a belief in the ideals which motivated it 

and by a willingness on the part of each individual to defend those ideals 

with personal sacrifice if necessary. If a society is not motivated by a 
sound ideology and is not willing to defend that ideology at personal loss to 
the individuals concerned, it will fly apart at the first sign of adversity. 

Defending a society is a complex and ever -continuing process, as 
dynamic and vital in peace as in war. Spiritual and intellectual leadership 
TBoist be provided, and these, in turn, must be protected. And yet, the 
clergy has always been underpaid in worldly goods and teachers have been 
the constant economic victims of taxpayers associations bent on holding down 
the real estate taxes. These two categories then are sacrificing themselves 
to protect our way of life and there are thousands of other underpaid over- 
worked volunteer "defenders of the faith" whose jobs could never be rational- 
ized in terms of dollars and cents and whose work would be uninspired if it 
were so rationalized. 

The word volunteer is important in the military also. One of the 
obligations of a society is to defend itself and its privileges from those who 
would rob it. Empirically, for the foreseeable future at least, a part of 
that protection is a sound military posture. 

The day has passed when we can sit back and say, "Let George do it. " 
:^ternational struggles and tensions, whether they manifest themselves in 
war, cold war, warm peace, or plain peace, are all encompassing. They 
are no longer limited to the family feuding of kings and the financial warfare 
of industrial barons. Only a realization of this principle and a hearty belief 
that we have something worth hanging on to will shake us away from our self- 
centered individualism sufficiently to produce a collective sense of social 
obligation which will produce enough top-caliber men who will stay voluntarily 
with the Service despite loss of pay, officers' clubs, commissaries, and other 
privileges, despite inexplicable operating procedures and bureaucratic obtuse - 
ness, despite unpleasant duty stations and a thousand other irritations. Be- 
cause, if these men have this conviction, they will know that they must stay 
with the Service if we are to maintain a sound foundation under what we are 
loud to proclaim as the finest way of life yet generated within man's knowledge. 

This collective attitude is hard to come by in an age of plenty. Once 
this attitude is implaced in our ideology, our problems will be solved, because 
then a man in the military can weather the disruptions of family life, tiresome 
institutional frustrations, and the day-by-day minutiae, and see the grand 
picture and the true worth of a career. 

In addition to the necessity for providing enough soldiers and teachers 
and preachers to support our way of life, we each have a responsibility to our 



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Medical News Letter, Vol. 27, No. 7 



own self-respect. A man must do more than earn his daily bread. Life 
must be led in such a way that we can look back on it and know we've given 
all we had to give. The whole Christian philosophy is anchored here, and 
from this principle, stem some of the most valuable psycho -therapeutic 
tools. The life of the financier is not complete until he has endowed a 
charity. All of the thousands of lay and civic organizations give active 
proof of the fact that we realize we must do more than merely sate our 
own earthly appetites. The man who does no more than put a good roof 
over his family's head and provide them with good food, school, clothes, 
and education is not a complete man until he has done something which he 
feels will make the world a better place. And a man can do no more for his 
society than to devote his career to that society's protection. The satisfac- 
tion gained from the pursuit of this life despite material and emotional incon- 
veniences will enable a man to look himself in the face in peace, knowing that 
he is doing as much in a lifetime as any man can. 

Fully believing this, and being reasonably adapted to military life, 
a man would need no further persuasion to make a career of the Armed 
Services. 

However, there are other considerations that are worthy of note be- 
cause they seem to be almost universally ignored and unanimously unappre- 
ciated. First, there is the matter of recognition and of pride in one's work. 
Industrial psychologists agree that these rank ahead of monetary benefits in 
holding employees. Recognition of the higher echelons in the business world 
is equally important in the eyes of management as is evidenced by the rigid 
protocol that governs the distribution of office space, expense accounts, and 
secretaries. Companies even publish manuals that fix such matters as rigidly 
as Uniform Regulations differentiate between captain and commander. 

Yet, when the junior and senior vice president leave the home office 
and go out into a new town, there is no recognition automatically accorded to 
either of them. They must sell themselves to a new community. Whereas, 
the man in the Service not only belongs to an organization that purveys a 
prestige product, but he also is accorded an instant recognition by virtue of 
the fact that he wears the uniform. He has "arrived" as soon as he does 
arrive in a new community because he is a known quantity to the people. This 
is so despite all the journalistic snipings at the military in recent years. It 
doesn't take him years to become a pillar of the community because the com- 
munity is ready to accept him as such on arrival. 

Pride in one's work has become more difficult in civilian life as the 
years have gone by. The inexorable rules of economics and technology have 
done away with craftsmen and replaced them with button pushers. But the 
man in the Navy will always have much more than a button to push. Pride 
in its most justifiable form comes continuously from seeing men mature 
under good leadership, from seeing these men directed in maintaining and 
training a combatant ship, from learning new situations in a minimum of tim e 
and knowing that one's work and training will save lives, money, and property. 



Medical News Letter, Vol. 27, No. 7 



9 



The next intangible asset of the man in the military is a strong 
feeling of belonging, identification with a dynamically motivated cohesive 
group. Most people are basically gregarious and preponderantly extrovert. 
There are very few complete individualists in the world. In some men, this 
need for identification is fulfilled by business completely. However, in the 
civilian world there are very few men who find this sufficient and almost 
every man belongs to the vestry of his church, or the Lions, or the Elks, 
or the Bar Association, or the Masons, or the Grange, or one of thousands 
of other fraternal or lay organizations, all of which substantiate by their 
existence the need for belonging. The Navy or the Army or any other branch 
of the Service satisfies this need infinitely more than any civic organization. 

Finally, on the subject of identification, the cause for which one 
works is a strong determinant of the cohesiveness of any group. Needless 
to say, the cause for which the Navy exists, namely the preservation of the 
state, is as fundamental and important as any cause save that of the Church. 

Another psychological need of man is better satisfied by the Navy life 
than by a great many other careers. That is the need to draw satisfaction 
from one's work on a day-to-day basis. There is no job that so constantly 
imposes responsibility on the individual as does the Service life. Now, much 
has been said about the taking away of responsibility from officers and petty 
officers, and there is a certain amount of rationalization in these accusations 
by men who don't want to take on the responsibility. The man who cares, 
if he could physically stand it, could work 24 hours a day and still not accom- 
plish all that needs to be done. The jttnior officer has a tremendous oppor- 
tunity to shape and mold the lives of his men for good or bad, and just to 
exert a favorable influence on them is a full time job. As a man moves up 
the chain of command, he then must work with and on his junior officers. 
It is a real challenge just to keep abreast of the technological revolution as 
it affects the Navy and to see that we are ready to extract as much from the 
machines as they have been built to give. The man who can't derive satis- 
faction from working in these directions will never find satisfaction in any 
work. 

Another asset of the military man is often labeled as a liability and 
rather neatly illustrates the point that we have been unnecessarily on the 
defensive in trying to keep our officers and men. Many people moan and 
groan about change. "I get settled into a job and two years hence, I'm routed 
out and sent on my way. " The man in the Service has the opportunity to shift 
from one horizon to the other. If personality clashes arise in one spot, one 
knows that there will be another spot in a finite length of time. But the cynic 
asks, "Won't that personality clash cost a man his next promotion? " That, 
of course, depends upon the junior and how successful he can be in sublima- 
ting his resentment. In any event, it is safe to say that it will result in no 
more, and probably less, damage than in a comparable civilian situation. 

Under the heading of change as an asset falls the favorite recruiting 
slogan, "Join the Navy and See the World. " This phrase is so commonplace 



10 



Medical News Letter, Vol. 27, No. 7 



that its value is not appreciated. Extremely few civilians liave both the 
time and the money to do the traveling that falls to the Navy man and, in 
a great many cases, to his family. Not only does the Navy man visit spots 
that would cost a mint to visit as a civilian, but he also gets to live in a 
great many of them and that is infinitely more valuable than "staying in 
Frisco tonight, hit L. A. tomorrow, Las Vegas the next day, " to quote 
a typical tourist card sent home. Within the States themselves, he lives 
in the North and the South and the West. He becomes a better citizen be- 
cause of this and his country means more to him. Even if he doepn't like 
any part of the country as well as his original home, he at least has satisfied 
himself that the grass is greenest on his own side of the fence. 

But let us exploit another line of thought, the matter of broadening 
one's outlook on life — the process of becoming a cosmopolitan as opposed to 
the provincial. No matter where a man is, or what he does, if he wants to 
stay narrow-minded he will stay that way. Some of our most provincial 
citizens come from the largest cities, whereas, some of our most enlightened 
and sophisticated philosophers have had nothing but bucolic roots. However, 
if a man is interested in improving his mental perspective, there is no place 
better than the Navy. The senior officer today must have a working know- 
ledge of economics, politics, law, diplomacy, management, technology, 
and the arts, to mention but a few, in order to be able to properly harness 
the organization placed in his charge and lead it to its ultimate goal. He must 
be an astute observer of human nature — which is a fascinating pursuit in 
itself — in order to work his men most effectively. He must be able to meet 
and deal with all strata and classifications, and, to do this, he must be an 
expert in humanity. In that, the Navy is a noble calling and draws strength 
from spiritual support, he' must appreciate the various religions and be re- 
ligious himself. Because the tools of our profession and the techniques of 
handling them have changed more in ten years than in two hundred before 
that, and because they promise more rapid changes ahead, he must practice 
mental flexibility and work at banishing dogmatism and pedantry from his 
mentality. The man that realizes all these things, and does something about 
them, will have a broad outlook and a rational mature philosophy. 

These, then, are some of the commodities that the Navy has to sell: 
a means of meeting one's social responsibility, a means of building one's 
self-respect, a means of satisfying one's need for recognition, pride in 
work and identification, a means of providing daily satisfaction, a means 
for providing stimulation through change, and the necessity for broadening 
one's outlook. In most cases, the Navy has a product of better quality in 
each instance than any other concern in the country, but it probably has the 
worst sales force in the world. I have already referred to statistics and . 
they have been talked about and been written about to the point that, when 
you do run into a man who is making the Navy a career, you are ready to 
embrace him on the spot. 



Medical News Letter, Vol. 27, No. 7 



11 



This situation exists at a time when we need a dedicated cadre of 
regulars to back up our national policies more than we ever have before; 
at a time when there is more international tension than ever before; at a 
time when there is more apocalyptic ammunition in the hands of international 
henchmen than ever has been before; and at a time when we are blessed with 
a material well-being as no nation in recorded history ever has been blessed. 

Yet, this appalling attrition in Service personnel exists when it costs 
more and takes longer to train a man than ever before and at a time when we 
are rapidly reaching the point at which industry can supply the machines, 
but we can't provide the men to run them. 

Why does this situation exist? There are two big reasons. In the 
first place, as we nationally have increased our material blessings we have 
not commensurately increased our collective sense of social obligation. Too 
many Americans have forgotten the old axiom that with privilege goes respon - 
sibility, and that if we neglect our responsibility, the privileges are apt to 
vanish in the smoke of a nuclear holocaust. 

In the second place, we in ^e Navy have allowed our critics to astig- 
matize our vision to the extent that we have ceased in a great many instances 
to believe in ourselves. When we cease to believe in ourselves we can't sell 
our way of life to those coming up behind us. 

What is to be done? Evangelism is tremendously successful in the 
churches and is just as appropriate in the military. Evangelism is an obliga- 
tion on the part of every communicant of every church, as a reading of certain 
passages of the Bible will show. It should also be an obligation on the part 
of every career man in the Navy. If we can believe these tenets ourselves 
and go out and sell them, all the rest of the materialistic problems will re- 
solve themselves in the good order of time, and our recruiting problems 
will cease to exist. (LT G. H. Gardner, Jr. , USN, Grow the Green Grass 
Here: U.S. Naval Institute Proceedings, 82: 137-143, February 1956, 
Copyright 1956 by the United States Naval Institute. ) 

Hodgkin's Disease 

The therapeutic activity and clinical use of chloroethylamines have 
been studied in the Academy of Medical Sciences of the U. S. S. R. , Moscow 
since 1947. While the author started treatment with di-(2-chloroethyl)- 
methylamine hydrochloride ( "embichin"), he began using another chemical 
compound from 1950 onwards. 

This new drug, called "novoembichin, " has been widely used since 
1952 in the medical institutions of the U.S.S. R. and has now replaced di- 
(2 -chloroethyl)methylamine. During the last four years, novoembichin 
only has been used in the treatment of Hodgkin's disease. It is given in 



12 



Medical News Letter, Vol. 27, No, 7 



larger doses than embichin, usually 9 mg. (less often, 8 or 10 mg. ) for 
adults. The number of injections varies from eight to sixteen. For the 
treatment of lymphoid leukemia, a dose of 8 mg, is used, and for myeloge- 
nous leukemia, 10 mg. 

The immediate and remote results of treatment of Hodgkin's disease 
with embichin and novoembichin according to this method are described. From 
1949 to 1955, the author has participated in the treatment of about 300 patients, 
100 of them at the Institute of Oncology at Leningrad (1949 - 1951) and about 
ZOO at the Institute of Experimental Pathology and Therapeutics of Cancer and ' 
other institutions in Moscow (1952 - 1955), 

In such a severe disease as lymphogranulomatosis, which tends to be 
generalized and to relapse, the results of treatment necessarily depend to a 
large extent upon the stage of the disease at which it is instituted and upon 
the type of disease, whether it is of slow or rapid course. Consequently, in 
order to summarize the results and to make a comparison with x- ray therapy, 
it was first of all necessary to note the stages of the disease. 

The author distinguishes four clinic|al stages in the course of Hodgkin's 
disease by analogy with malignant tumors, which are divided into stages in 
the U. S. S. E. 

In the first stage are those patients with the initial form of the disease, 
in whom the pathological changes are confined to one group of lymph nodes 
(^or instance, in the cervical region) and general clinical symptoms are 
absent. The disease does not progress for some time in most cases at this 
Stage, apparently owing to the effectiveness of the bodily resistance. This 
stage, closely resembling the latent period described by other authors, lasts 
several months, sometimes 1 or 2 years, but is seldom diagnosed as Hodgkin's 
disease at this period. 

The second stage is also the initial period of the disease, but the 
process is beginning to develop, indicating a failure of the compensatory 
forces of the body. There are still mild general symptoms with a rise in 
evening temperature. Granulomatous changes in the lymph nodes and in- 
volvement of other nodes, such as in the mediastinum or axillary region, take 
place, but the nodes are still not greatly enlarged. This stage can be desig- 
nated the initial progressing stage. 

The third stage (the stage of significant spread along the lymphatic 
system) characterizes the completely developed illness with marked general 
symptoms, loss of working capacity, fever, and pruritus. The changes in 
the lymph nodes have progressed and involved many groups of nodes, some 
of which become much enlarged. 

The fourth stage includes patients with anemia, emaciation, loss of 
working capacity, generalized pathological changes in the lymph nodes, and 
sometimes pulmonary, pleural, and bony involvement. At this stage, bodily 
resistance becomes almost exhausted. 



Medical News Letter, Vol. 27, No. 7 



13 



The foregoing classification is applied to chronic cases of Hodgkin's 
disease, as it is almost impossible to differentiate these stages in acute 
cases and in those rimning a rapid course. It is difficult to define the early 
stages in those forms of the disease in which the mesenteric nodes are 
initially affected. It is advisable to classify patients with chronic Hodgkin's 
disease according to whether the course is slow, moderate, or rapid. 

Of the 300 patients admitted for treatment, about 25% were classified 
as in the second stage, about 50% in the third stage, and about 25% in the 
fourth stage. 

The treatment gave immediate positive results in nearly all the patients. 
These included a decrease in size of the affected nodes or their complete re- 
gression, disappearance or amelioration of general symptoms such as fever 
and pruritus, and partial or complete recovery of working capacity. The best 
results were observed in patients in the second or the beginning of the third 
stage, with affected cervical, mediastinal, and axillary nodes, who had 
received no previous treatment, or only one or two courses of radiotherapy. 
The worst results were observed in patients at the end of the third and fourth 
stages, particularly those with involvement of the retroperitoneal nodes, and 
in a number of patients previously subjected to radiotherapy, repeatedly 
applied to various sites. Occasionally, in such patients, chemotherapy had 
to be discontinued because of the rapid depression of hemopoiesis. 

In spite of good immediate results, relapses were observed in many 
cases. However, in 4 patients out of 25, whose treatment was started in the 
second stage (none of whom had been treated previously), no relapses have 
occurred to date; one was followed up for 3 years, one for 4 years, and the 
third for 6 years after the first course of treatment, and one patient for 4 
years after the second course. Other patients had relapses in 6 months to a 
year after each course of treatment. 

In patients in the third and fourth stages, particularly those with 
affected retroperitoneal nodes and who had received radiotherapy, relapses 
occurred earlier, in from 2 to 6 months, seldom later. To prevent or delay 
relapses, it proved helpful in a few cases to give an additional (prof>hylactic) 
course of injections of shorter duration soon after the main course of treat- 
ment. In many cases, further courses of treatment during relapses gave the 
same good results as the first course. It is most important to repeat the 
treatment at the onset of the relapse when symptoms first appear. If treat- 
ment is delayed, not only do relapses occur, but the next stage of the illness 
sets in, with deterioration in the patient's condition. Even short delays should 
be avoided, for relapses often tend to progress rapidly. To each of the patients 
in the present series, from one to six repeated courses of injections of em- 
bichin and novoembichin were given. In some cases, repeated courses of 
injections became difficult owing to the poor condition of the veins, so that 
radiotherapy was sometimes necessary. 



14 



Medical News Letter, Vol. 27, No. 7 



Among the aliphatic chloroethylamines , 2 chloropropyldi -(Zchloro - 
ethyl) amine hydrochloride (novoembichin), with a milder side -effect upon 
the gastrointestinal tract and a weaker action on the bone marrow than other 
compounds of the series, is the most suitable drug for the treatment of Hodg- 
kin's disease. 

The prolonged method of treatment with thrice-weekly injections has 
been found the most suitable. Usually, 8 to 16 injections are necessary. 
Injections are continued until the leukocyte count falls to 2500 - 3000 per 
c.mm. If this fails to produce complete regression of lymph nodes, an 
additional course of treatment is given 6 weeks later. To prevent relapses, 
a supplementary (prophylactic) course of injections of shorter duration after 
an interval of 2 to 3 months has been found useful. 

Treatment with chloroethylamines should be given not only in the 
advanced stage of the disease when x-ray therapy has proved unsuccessful, 
but also in the early stages. 

With such treatment, provided it is given in the early stages and 
according to a rational method, positive remote results — that is, preserva- 
tion of life and working capacity for more than 5 years from the beginning of 
treatment — may be obtained in 50% of cases. 

The immediate and late results of chloroethylamine treatment of early 
cases of Hodgkin's disease are at least as good as those of x-ray therapy. 

The above two treatments are applicable in combination, the following 
two methods having been found useful in the author's hands: (1) an initial 
course of chemotherapy is given, and this is followed after an interval of 6 
to 8 weeks by x -irradiation of nodes which have not completely regressed; 
or (2) the two methods of treatment are applied alternately in subsequent 
relapses. 

A new drug — 2:6-dioxy-4methyl-5-{e-chloroethyl) aminopyrimidine 
(dopan) — has been developed which, as it can be administered orally and has 
only a slightly toxic action on the gastrointestinal tract, renders the chemo- 
therapy of Hodgkin's disease more convenient for the patient, one tablet 
being given twice weekly for 3 to 5 weeks. (Larionov, L. F. , Immediate 
and Remote Results of Chloroethylamine Treatment of Hodgkin's Disease: 
Brit. M. J. , 4961 : 252-256, February 4, 1956. Institute of Experimental 
Pathology and Therapeutics of Cancer, Academy of Medical Sciences of the 
U. S.S.R., Moscow) 

Aldosterone in Clinical Medicine 

The time has arrived for clinicians to become aware of the increasing 
importance in clinical medicine of aldosterone, the newly discovered adrenal 
cortex hormone. It has been demonstrated that increased adrenal production 



Medical News Letter, Vol. 27, No. 7 



15 



of aldosterone is involved in the pathogenesis of a number of very common 
clinical disorders. That many more diseases will be found to be associated 
with increased or decreased secretion of this hormone seems abundantly 
clear. This prediction is based not only upon the numerous possibilities 
which exist, but also upon the fact that clinical investigators have merely 
scratched the surface of this fertile field since the hormone was proved to 
exist and shown to be measurable. 

The purposes of this brief review are (1) to provide that small measure 
of historical information which is essential for proper orientation to the clin^ 
ical problems, \2} to delineate and classify the various clinical states in 
which abnormal production of aldosterone is now known to exist and to specu- 
late upon the existence of others, and (3) to describe in detail primary aldos- 
teronism, the newly recognized clinical syndrome. Emphasis is given to 
this condition because it is a serious hypertensive -renal-vascular disease 
and represents the one condition to date of the entire "aldosterone group" 
which can be completely cured. 

The history of aldosterone is still in the making. It goes back only 
to 1952, when Simpson, Tait, and their co-workers detected biologically, 
and isolated chromatographically from the "amorphous fraction" of adrenal 
cortex extract, something which caused intense retention of sodium and diur- 
esis of potassium in adrenalectomized rats. The potency of this material 
was so great that these investigators realized at once that they were not deal- 
ing with any of the known corticosteroids or with any combination of them. 
They and Farrell and Richards demonstrated the existence of this material in 
the adrenal venous blood of monkeys and dogs. This constituted good evidence 
that this substance was a normal secretory product of the adrenal gland. Be- 
cause of its potent effect upon electrolyte metabolism {30 times greater on 
sodium retention and 5 times greater on potassium diuresis than desoxycor- 
ticosterone) the material was tentatively given the name "electrocortin. " 

Then ensued in relatively rapid succession, isolation of the compound 
in pure crystalline form, identification of its chemical structure, and, in July 
1955, actual synthesis of the compound. 

From the clinical point of view, it had been suspected that the adrenal 
was capable of secreting a powerful electrolyte -regulating hormone, although 
it was assumed by many without proper justification that this steroid was 
probably desoxycorticosterone. The latter has been used to regulate elec- 
trolyte metabolism in patients with Addison's disease since Steiger and 
Reichstein synthesized the compound in 1937. When cortisone and hydro- 
cortisone became available for substitution therapy in Addison's disease, 
it was quickly apparent that doses of these compounds adequate to normalize 
organic metabolism (protein, carbohydrate, et cetera) lacked the capacity 
to maintain normal metabolism of sodium and potassium. It was found neces- 
sary to give these patients desoxycortocosterone in addition to maintenance 
quantities of cortisone or hydrocortisone. Corticosterone, however, was 
found to provide in a single compound, good replacement therapy. 



16 



Medical News Letter, Vol. 27, No. 7 



A table presents a tentative etiological classification of hyperaldos - 
teronism and hypoaldosteronism . Included are the clinical conditions now 
known to be associated with abnormal production of aldosterone. In addition, 
it will be noted that names have been given to conditions which are not yet 
recognized as existing. The authors believe that many of them will be found 
to occur. 

Hyperaldosteronism is divided into two main subgroups, primary 
aldosteronism and secondary aldosteronism. The former is meant to denote 
an abnormality of the adrenal cortex which, per se, gives rise to secretion 
of excessive amounts of aldosterone. Secondary aldosteronism indicates a 
situation in which excessive production of aldosterone is the result of an- 
abnormality which has arisen outside the adrenal gland The adrenal then 
responds normally to an intense physiological stimulus or stimuli capable 
of evoking increased secretion of aldosterone. Secondary hormonal secre- 
tory activities of this nature are usually compensatory and are designed to 
overcome or buffer a biochemical abnormality which has arisen. 

A similar division into subgroups has been assigned to hypoaldos- 
teronism, primary aldosteronopenia indicating an abnormality of the adrenal 
itself, and secondary aldosteronopenia representing a compensatory reduc- 
tion of aldosterone production based upon an extra-adrenal abnormality. 
(Conn. J. W. , Aldosterone in Clinical Medicine — Past, Present, and Future: 
Arch. Int. Med., 97: 135-142, February 1956) 

3(: :jc # « 

Listeria Meningitis 

The organism causing listeria meningitis was first isolated from 
rabbits by Murray and associates in 1926, and was described under the name 
of Bacterium monocytogenes because of the mononuclear leukocytosis which 
occurred in these animals. 

Before the use of sulfonamides and antibiotic drugs, human listeria 
infection was usually fatal. Handleman and co-workers reported a patient 
with listeria meningitis who responded to penicillin and sulfadiazine. Other 
reported cures, with one or both of these drugs, followed. Broad spectrum 
antibiotics have been reported used successfully by Binder and associates 
who used streptomycin and chloramphenicol, and Portero and Despirito who 
used Aureomycin and chloramphenicol. 

The recent literature on human listerellosis would indicate that the 
infection is quite rare; however, the infection is probably more common 
than realized. The reason that more cases have not been diagnosed very 
likely has been due to two sources of confusion with regard to identifying the 
etiological agent. Because L. monocytogenes morphologically resembles 
the common corynebacteria and also possesses other characteristics of the 



Medical News Letter, Vol. 27, No. 7 



17 



diphtheroids, it no doubt has been overlooked and considered a contaminant 
or nonpathogen. Reports in the literature, early as well as recent, would 
indicate this to be the case; in fact, some of the recent reports have indicated 
that the organism was first reported a diphtheroid and then more careful 
study showed it to be L. monocytogenes. Another source of confusion is 
that L,. monocytogenes appears as a small round colony with clear zone 
hemolysis on blood agar quite like colonies of beta streptococci, and the 
organism has a tendency to form short chains in trypticase -soy broth so 
that it has been mistakenly assumed to be a beta streptococcus. The recent 
literature shows at least one report of where the organism was first called 
a beta streptococcus and subsequently identified as L,, monocytogenes. 

Infections with L. monocytogenes have been described throughout the 
world in both human beings and domestic animals. The organism has been 
isolated and identified from 27 animal species, and it appears to be primarily 
an animal pathogen. In domestic animals, it may produce a severe fatal dis- 
ease such as meningoencephalitis in cattle, sheep, and goats; or the organism 
may be isolated from animals with little or no indication of illness, in which 
case a carrier state probably exists. Little is known about the transmission 
and maintenance of this organism. Because a number of the reported cases 
of human infection have been in infants but a few days old, it would seem that 
the infection may occur by way of the placental or vaginal route. The organ- 
ism has been isolated from the genital tract of several animal species. 

It should be emphasized that therapy must be continued until two spinal 
fluid tests are entirely normal and the patient is clinically well. Portero and 
Despirito report that insufficient therapy with chlortetracycline and chloram- 
phenicol, at least, may cause the organism to develop resistance to these 
drugs. In 1945, before sulfonamide drugs were used in the treatment of 
listeroUosis, the mortality rate was 74% in the reported cases. Now, with 
broad spectrum antibiotic drugs, the patients in the few cases reported have 
responded well, with the organism showing sensitivity to all agents. 

A striking observation in listeria meningitis in both of the authors' 
cases, and also in those reported in the literature, has been the misleading 
symptomatology. The newborn infant may have poor feeding, diarrhea, 
cyanosis, drowsiness, or convulsions. The second case was felt to be a 
cardiorespiratory case with recurrent apnea until it was suggested that the 
infant might have a meningitis. 

Listeria meningitis simulates tuberculous meningitis in several res- 
pects. The spinal fluid may be clear. In both cases, the spinal fluid showed 
a pleocytosis with polymorphonuclear leukocytes predominating early and 
then lymphocytes predominating later in the course of the infection. One must 
consider iisterellosis in a case such as this, for if the organism can be isola- 
ted and identified, the prognosis may be altered greatly and the prolonged 
therapy indicated for tuberculous meningitis will be unnecessary. 

It is very likely that L. monocytogenes, isolated from patients with 
meningitis, has been called a diphtheroid because of similarity in cell and 



18 



Medical News Letter, Vol. 27, No. 7 



colony morphology, or a beta streptococcus, because of similarity in colony 
appearance on blood agar. This organism is not at all fastidious in regard 
to cultural and nutritional requirements as is true of the more common bac- 
terial etiological agents of meningitis. However, if this species is kept in 
mind when examining spinal fluid, and if the isolate is observed carefully 
for distinctive identifying traits, more cases of Listeria infection will be 
diagnosed. (Mathieu, P. L. Jr., et al, Listeria Meningitis : J. Pediat. , 
48: 349-354, March 1956) 

3^ Sjc j{C 3(C 3|C 

Roentgenologic Diagnosis of Ruptured Spleen 

Rupture of the spleen, a frequent acute abdominal condition character- 
ized by symptoms and signs of internal hemorrhage and shock, necessitates 
surgical intervention, usually splenectomy. 

X-ray examination of the abdomen is extremely useful in the diagnosis 
of acute abdominal disease and particularly in rupture of the spleen. It is the 
purpose of this investigation to determine the significance of the roentgeno- 
logic manifestations observed in a group of 43 patients with ruptured spleen, 
seen at the Massachusetts General Hospital from 1945 to 1955 inclusive. 

Of the total group, there were 33 patients in whom adequate roentgeno- 
grams of the abdomen were available for review. Nineteen patients had direct 
or indirect evidence of enlargement of the splenic shadow; in 14, there was no 
enlargement. Enlargemeint was demonstrated directly by visualization of the 
actual splenic outline and was estimated by means of the position of the sur- 
rounding structures, particularly the gas -containing splenic flexure of the 
colon, the left hemidiaphragm and the gas -filled stomach. Enlargement of 
the splenic shadow is due to a localized collection of blood around the organ, 
with or without intracapsular hematoma. 

In a satisfactory roentgenogram of the normal abdomen, several of 
the visceral outlines aie readily recognizable: the spleen by virtue of adjacent 
air -containing organs, and the renal outlines and the psoas shadows by the 
presence of surrounding fat. Experience has shown that these landmarks can 
be seen in almost all patients, and they should be meticulously searched for in 
the evaluation of acute abdominal conditions. In the presence of retroperi- 
toneal edema or hemorrhage, or both, around the particular organ, its out- 
line becomes obliterated. Of 33 patients with ruptured spleen, 25 showed 
complete and 6 partial obliteration of the splenic outline. In only 2 patients, 
who had intracapsular hemorrhage, was the organ clearly seen. 

It should be emphasized that unilateral absence of renal outlines or 
psoas shadows is diagnostically significant in the recognition of acute abdom- 
inal disease. In trauma, retroperitoneal edema or hemorrhage into the nor- 
mally conti^asting fatty tissues results in the loss of outline of the structure 



Medical News Letter, Vol. 27, No. 7 



19 



involved. In this study, 18 patients showed complete and 7 showed partial 
obliteration of the left renal outline. It was sharp and distinct in 8 cases. 
In 6 patients, the left kidney was displaced inferiorly as determijied either 
by its direct visualization or by intravenous urography. The psoas shadows 
showed very important changes in rupture of the spleen, usually because of 
the associated retroperitoneal hemorrhage or edema — a fact that has not 
oJten been recognized. Of 33 patients examined, there were 14 in whom the 
left psoas shadow was completely obliterated; in another 5, it was not seen 
clearly as compared to the right; and in 14, both psoas shadows were clearly 
and sharply delineated. 

Considerable emphasis has been placed on the value of serration of 
the greater curvature of the stomach in the diagnosis of ruptured spleen. In 
this series, there were I6 patients (50%) in whom this x-ray manifestation 
was present in a questionable to definite degree. Localized indentation and 
medial displacement of the stomach due to a splenic hematoma and enlarge- 
ment can also be seen either on plain roentgenograms as outlined by air or 
by contrast study of the upper gastrointestinal tract. There is associated 
slight elevation of the left hemidiaphragm, with limitation of movement. 
The importance of fluoroscopic observation of the left hemidiaphragm cannot 
be overemphasized, but this procedure may be resorted to only in rare cases 
when the patient's condition is relatively good. 

The fact that the spleen may be ruptured immediately after severe 
trauma is well known; the possibility of delayed rupture up to several weeks 
after minor injury with sudden massive intraperitoneal hemorrhage is less 
well appreciated and should hk emphasized. The diagnostic signs of ruptured 
spleen on the x-ray film vary. In this series of 33 patients, obliteration of 
the splenic outline, enlargement of the splenic shadow, loss of left renal and 
psoas shadows, and serration or localized indentation of the greater curva- 
ture of the stomach were frequent, and, therefore, should be considered as 
of diagnostic significance. Inferior displacement of the left kidney and widen- 
ing of the left paravertebral soft-tissue shadow should constitute additional 
signs of this acute abdominal condition. Fractured ribs on the lower left are 
not necessarily a concomitant of ruptured spleen, but their presence should 
arouse even more critical appraisal of other findings suggesting the diagnosis. 
Differential diagnosis should include rupture of the kidney and perforation of 
the stomach and intestine. In a film of the abdomen taken with the patient 
upright, the presence of free air beneath the diaphragm often indicates per- 
foration of a hollow viscus. Extravasation of contrast material into the paren- 
chymal tissue, with diminution of renal function, points to rupture of the 
kidney. It should be noted that rupture or contusion of a kidney and rupture 
of the spleen may be coexistent and their differentiation in isolated instances 
maybe difficult. (Wang, C.C., Robbins, L. L. , Roentgenologic Diagnosis 
of Ruptured Spleen: New England J. Med. , 254: 445-449, March 8, 1956) 



9j: :^ 9}: 



20 



Medical News Letter, Vol. 27, No. 7 



Metastatic Pulmonary Malignancy 

The purpose of this presentation is to emphasize the fact that, 
in patients in whom there is reasonable evidence that a primary malignancy 
has been controlled, the presence of a discrete pulmonary lesion is an 
absolute indication for thoracotomy. Not only is there a fair chance of con- 
trolling the metastatic lesions, but the real possibility that a second primary 
pulmonary malignancy may coexist is ever present. The first point for con- 
sideration is then the present status of the primary lesion. Obviously, to 
the patient with local persistence of disease, or with metastases in other 
organs, excision of the pulmonary lesion offers no real benefit. Indiscrimi- 
nate exploration, even in the face of a hopeless prognosis, becomes sense- 
less mutilation. Unfortimately, the only criteria presently available for 
evaluating the operability of these patients are those obvious factors which 
are immediately apparent on considering the subject. 

In most instances, it has long been known and accepted that the nature 
of a localized or roimded intrapulmonary density cannot be determined except 
by histopathologic section. When this circumstance occurs in an individual 
who has harbored or does at that time harbor a known neoplasm of malignant 
mien, the probability that the pulmonary lesion is likewise a neoplasm is 
undoubtedly increased. The inclination has been to consider the pulmonary 
lesion as representing a metastatic deposit from the original neoplasms 
because the lungs form such a predilect site for the deposition of such lesions. 

The increased incidence of bronchogenic carcinoma, particularly in 
the male sex, highlights the possibility that a second neoplasm, occurring in 
a man, would be of such nature. Even though metastatic lesions to the lung 
may lodge in such manner as to involve the bronchus, the classical roentgen 
picture is, however, that of a discrete parenchymal shadow. It is that select 
group that interested the authors. Thus, this study is concerned only with 
the possible incidence of a bronchogenic carcinoma occurring under circum- 
stances that would be most confused with a metastatic pulmonary lesion. 
There is no available means of determining whether such a lung lesion repre- 
sents a metastasis or a new tumor, and at times this is so even when both 
lesions are subjected to microscopic examination because bronchogenic car- 
cinoma can resemble tumors arising in other organs. From a clinical stand- 
point, to be able to decide this issue accurately would be very gratifying 
because it is suggested in the authors' experience that metastatic tumors 
may remain localized for a reasonably long period of time, even though the 
possibility of producing daughter metastases must be considered. If advan- 
tage were taken of such time, greater assurance might be had concerning 
the solitary nature of the metastatic involvement as well as further observa- 
tions concerning the degree of control at the primary site, thereby avoiding 
some futile operation. On the other hand, the authors are hesitant to take 
this time for observation because there is no such "period of grace" in the 



Medical News Letter, Vol. 27, No. 7 



21 



event the lung lesion represents a second primary carcinoma. Thus, no 
alternative is left but to be bold in attacking discrete pulmonary densities 
under such circumstances. 

The presence of pulmonary metastases should not be considered to 
be necessarily indicative of a fatal prognosis. The surgical excision of 
metastatic malignancy of the lung has been shown to be technically feasible 
and productive of a significant group of long-term survivors in selected cases. 
All such patients should be carefully evaluated, and where the primary lesion 
can be shown to be well controlled, and no other metastases can be found, tho- 
racotomy and excision of the metastatic lesions are indicated. It must also 
be realized that the mere history of former malignancy, in the presence of 
a pulmonary lesion, does not necessarily indicate the latter's metastatic 
nature because in a significant number of cases such a pulmonary lesion 
actually is a second primary tumor. The differentiation between these two 
situations is clinically very difficult, if not impossible. Even though failing 
occasionally, histologic study of these lesions remains the only reasonably 
satisfactory approach to the question. In the final analysis, however, only 
time can tell whether judgment in any given case was good or bad. (Kelly, C. R. , 
Langston, H. T. , The Treatment of Metastatic Pulmonary Malignancy: J. 
Thoracic Surg., 31: 298-315, March 1956) 

Monograph on Frostbite - 
Translated by Dr. Iser Steiman 

The Chairman for the Canadian Defense Research Board has informed 
the Bureau of Medicine and Surgery that further copies of the subject mono- 
graph are no longer available. It is expected that in the near future a more 
recent bibliography on cold weather medicine will be available and will be 
published in the Medical News Letter at a future date. (Refer: U.S. Navy 
Medical News Letter, Vol. 27, Number 4 of 17 February 1956. ) 

r/jf ^If if: iff sjt If/: 

Standard First Aid Training C ourse 

The Standard First Aid Training Course (NavPers 10081) is a Navy 
Training Course prepared by the U.S. Naval Training Publications Center 
for the Bureau of Naval Personnel with technical assistance furnished by the 
Bureau of Medicine and Surgery. The course is designed for individual study 
and may also be used as a basic text for group instruction in first aid procedures 
aboard ship or at naval shore establishments with primary emphasis being 
placed on shipboard first aid problems. NavPers 10081 may be procured 
officially from all District Printing and Publication Offices. (ProfDiv, BuMed) 



22 



Medical News Letter, Vol. 27, No. 7 



From the Note Book 

1. Rear Admiral B. W. Hogan, Surgeon General of the Navy, will visit 
Navy Medical installations in the Pacific Islands and the Far East at an early 
date. Accompanying the Surgeon General as advisor and consultant, will be 
Dr. Paul Dudley White. Enroute, Dr. White will lecture to medical staff 
personnel and conduct heart clinics at each place visited. The itinerary 
includes stopovers at Honolulu, T. H. , Guam, M.I. , Manila, Philippine Is. , 
Tokyo, Japan, and Formosa. (TIO, BuMed) 

2. Rear Admiral F.R. Moore, MC USN, Assistant Chief for Planning and 
Logistics, will visit various naval medical facilities and bases in the Middle 
East, Europe, and Africa. (TIO, BuMed) 

3. Captain L. B. Shone, MC USN, was awarded the National Safety Council 
President's Medal at a ceremony held in the Pentagon, Friday, March 9, 1956. 
This medal is given only for successful resuscitation in order to save life by 
the Schafer Prone Pressure or Holger Nielsen Arm -Lift Back-Pressure 
Methods; only 2000 m edals have been awarded since 1928. {TIO, EuMed) 

4. The U. S. Naval Hospital, Memphis Tenn, , was host to members of the 
Memphis -Shelby County Medical Society on 6 March 1956 at a joint meeting 
of the Society and Hospital Staff. One hundred and five civilian physicians 
and twenty-six military physicians attended the meeting. The professional 
program consisted of three papers presented by the Hospital Staff. (USNH, 
Memphis, Tenn.) 

5. Radioactivity was the subject of one of the seminars that were part of 
the course in Pathology of the Oral Regions given by the Armed Forces 
Institute of Pathology, March 26 - 30. General practitioners, university 
teachers of dentistry, and pathologists were among the 115 students from 
throughout the United States who attended the week-long course at AFIP. 
(AFIP) 

6. Five young scientists who have shown special promise of becoming crea- 
tive leaders in basic research have been awarded Postdoctoral Research 
Associateships for advanced study at the National Bureau of Standards. The 
associateship program is sponsored jointly by the National Academy of 
Sciences -National Research Co\mcil and NBS. (NBS) 

7. Construction and presentation of the below named BuMed exhibits at the 
Aero Medical Association Convention, to be held at the Drake Hotel, Chicago, 
April 16 - 18, 1956, have been approved: 



Medical News Letter, Vol. 27, No. 7 



23 



Aero Medical Acceleration Laboratory, Johnsville, Pa . 

Determination of Cerebral Blood Flow Using Radioactive Crypton. 

Aeron autical Medical Equipment Laboratory, Philadelphia, Pa. 

Anti -Exposure Suit Mark V; Nine Safety Flight Helmet; Summer 
Flight Suit; Static Pulsating, Vibrating Seat and Back Pads; Two- 
Piece Flight Suit; Oxygen Equipment; Pressure Suit; and Winter 
Flight Suit, 

U S. School of Aviation Medicine, Pensacola, Fla, 

Dynamic Visual Acuity Testing - Cadet Selection 
U.S. Naval Medical Research Laboratory, New London, Conn. 

Color Target Detectability at Sea 
Office of Naval Research, Washington, D. C . 

Hoover Cockpit (TIO, BuMed) 

8. A report considers recent progress in the study of 4 types of acute res- 
piratory infections : acute respiratory disease; nonbacterial pharyngitis ; 
primary atypical pneumonia; and the common cold. Sufficient evidence has 
accumulated to suggest that these 4 types are separate entities, although 
each type may be produced by more than one distinct virus. (New England 
J. Med., 8 March 1956; J. H. Dingle, M. D. , A. E. Feller, M. D. ) 

9. A case of a severe fulminating near-fatal anaphylactic reaction following 
the third intrapleural injection of streptokinase - streptodornase is reported 
to emphasize the definite antigenicity of the drug which apparently increases 
with repeated injections. {J. Thoracic Surg., March 1956; W.C. Shands,M. D. , 
J. H. Johnston Jr. , M. D. ) 

10. An analysis of 17 cases of marginal ulcer, occurring in 20 patients, is 
made. The proper management of marginal ulcer is presented. (Surgery, 
March 1956; L. Smith. M. D, , V. M. Strange, M. D. ) 

11. The diagnosis of cor pulmonale, heart disease secondary to lung disease, 
calls for close cooperation between the chest physician and the cardiologist. 
Inasmuch as the cardiac involvement is rooted in the underlying pulmonary 
dysfunction, therapy must be directed at both pulmonary and cardiac aspects 
of the disease^ (Dis. Chest, March 1956; G.C, Griffith, M. D. ) 

****** 
Board Certifications 



American Board of Internal Medicine 

LT Jack Barrow MC USNR (Inactive) 

Lt William B, Buckingham MC USNR (Inactive) 

LT David C. Bunch MC USNR (Inactive) 



24 



Medical News Letter, Vol. 27, No. 7 



LTJG Merrill C. Daines MC USNR (Inactive) 
LT Wilson H. Hartz, Jr. MC USNR (Inactive) 
LT Donald K. Hawley MC USNR (Inactive) 
LT David A. Howell MC USNR (Inactive) 
LTJG George E. Magnin MC USNR (Inactive) 
LTJG Edwin L. Slentz MC USNR (Inactive) 
LT Morris Statland MC USNR (Inactive) 
CDR Marcel P. Thomas MC USNR (Inactive) 
LT Irenaeus N. Tucker MC USNR (Inactive) 
LT Frank A. Ubel, Jr. MC USNR (Inactive) 
LTJG Mark Upson, Jr. MC USNR (Inactive) 
LTJG Burton A. Waisbren MC USNR (Inactive) 
LT ParkW. Willis, III MC USNR (Inac tive) 
LT Arnold Wollum MC USNR (Inactive) 

American Board of Obstetrics and Gynecology 

LCDR Robert G. Arrington MC USNR (Inactive) 
LTJG Herman L. Earnhardt, Jr. MC USNR (Inactiv 
CAPT James P. Moran MC USN 

American Board of Ophthalmolo gy 

~ CAPT Virgil A. Beuerman MC USN 

American Board of Orthoped ic Surgery 

LT Frank H. Burchell MC USNR (Inactive) 

American Board of Patholo gy 

LT Ralph Fargotstein MC USNR (Inactive) 

American Board of Pediatric s 

LTJG Isaac N. Gould MC USNR (Inactive) 
LT Howard E. Hansen MC USNR (Inactive) 
LT Benjamin H. Kennedy, III MC USNR (Inactive) 

American Board of Psychiatry and Neurology in Psychiat ry 
LT Richard S. Blacher MC USNR (Inactive) 
LCDR Julius G. Colantuono MC USNR (Active) 
LT W. F Fry, Jr. MC USNR (Active) 
LT Kenneth P. Jones, III MC USNR (Inactive) 
LT John I. Langdell MC USNR (Inactive) 
LT N. M, Margolis MC USNR (Active) 
. LT Sidney Merlis MC USNR (Active) 
LT E.R. Tetreault MC USNR (Active) 
CDR H.A. Wilmer MC USNR (Active) 



Medical News Letter, Vol. 27, No. 7 



25 



American Board of Radiology 

LTJG William J. Tuddenham MC USNR (Inactive) 

American Board of Surgery 

LTJG Arthur A. Anderson MC USNR (Inactive) 
LT Stuart M, Anderson MC USNR (Inactive) 
LTJG George F. Asbury MC USNR (Inactive) 
LT James W Barrett MC USNR (Inactive) 
LTJG James H. Cooper MC USNR (Inactive) 
LTJG Rudolph G. Matflerd MC USNR (Inactive) 
LTJG Oliver J. Purnell, Jr. MC USNR (Inactive) 
LTJG Thomas P. E. Rothchild MC USNR (Inactive) 
LTJG Edward D. Sullivan MC USNR (Inactive) 

American Board of Uro logy 

LCDR Earl W. Clawater, Jr. MC USNR (Inactive) 

^ sjc i{c 3fi 

BUMED INSTRUCTION 6410. lA 3 March 1956 

From: Chief, Bureau of Medicine and Surgery 
To: Distribution List 

Subj: Ejection Seat Trainers, Devices 6-EQ-2a and 6-EQ-2b 

Ref: (a) ManMed Art. 16-60(2) (e) 

(b) OpNavInst 3740. 3 A 

(c) BuMedlnst 3740. 1 

This instruction provides technical and procedural information to personnel 
concerned with ejection seat indoctrination employing the Ejection Seat Train- 
ers, Devices 6-EQ-2a and 6-EQ-2b. BuMed Inst. 6410. 1 is canceled. 

****** 

BUMED NOTICE 5202 6 March 1956 

From: Chief, Bureau of Medicine and Surgery 

To: BuMed Management Control Activities (as indicated) 

Subj: Fiscal Services Work Measurement Program 

This notice cancels BuMed Instruction 5202. 1 which required that monthly 
reports be submitted under the Fiscal Services Work Measurement Program. 



26 



Medical News Letter, Vol. 27, No. 7 




Dr. Harry Lyons Appointed Honorary Civilian Consultant 



The Secretary of the Navy has recently approved the contract to have 
Dr. Harry Lyons, Richmond, Va. , President- Elect, American Dental Assoc- 
iation, serve as Honorary Civilian Consultant to Rear Admiral B, W. Hogan, 
MC USN, Surgeon General of the Navy. 

****** 



Dental Personnel Briefs 

1, The present percentage grade structure of the Naval Dental Corps 
appears like this: 26% are in the grade of Captain, 11% in the grade of 
Commander, 9% in the grade of Lieutenant Commander, and 54% in the 
grade of Lieutenant and Lieutenant (Junior grade) 

2. At present, there are four avenues by which a Reserve Dental officer 
may become a regular Dental officer: 

a. Through the provisions of Public Law 365. For further informa- 
tion, read BuPers 1120. 3C of 10 August 1955, and Recruiting 
Service Instruction 315. 1 of 21 December 1955. 

b. The Augmentation Program. For further information, read 
BuPers Instruction 1120. 12D of 28 October 1955. 

c. The Senior Dental Student Program. Further information is 
available at the Offices of Naval- Officer Procurement. 

d. The Dental Intern Training Program. Further information is 
available at the Offices of Naval Officer Procurement. 

Reserve Dental Officers Selected for Promotion to Captain 



Listed below are Dental officers of the Naval Reserve not on active duty 
who have recently been selected for promotion to the grade of Captain: 



Medical News Letter, Vol. 27, No. 7 



27 



Name 

Archer, Evert A. 
Armbrecht, Edward C. 
Armstrong, William E. 
Beazley, William A. 
Beekman, Abram R. , Jr. 
Behrendt, Frederick 
Belanger, George H. 
Blackstone, Clarence H, 
Boege, John N. 
Brown, Theodore L. 
Buxton, Samuel E. , Jr. 
Carr, Harry L. 
Casper, Michael V. 
Coleman, George J. 
Gummings, John P. 
Curtis, Leslie B. 
Cutts, William E, 
Dickson, William A. 
Dittes, Robert M, 
Dunn, Robert L. 
Edwards, Roger J. 
Eller, Robert L. , Jr. 
Farwell, Howard M. 
Fitzgerald, Don J. 
Flint, John E. 
Fortelka, George C. 
Frame, Carl H. 
Gehring, Harry L. 
Gordon, Edwin V. 
Grayburn, Wayne G. 
Hall, William A. , Jr. 
Hanson, Donald F. 
Harris, William D. 
Hellweg, Harold P. 
.: Homichko, Nicholas E. 
Horner, Stuart J. 
Hoyt, Charles D. 
Kellogg, Richard M. 
Lachmann, Clarence M, 
Litman, Hyman 
Looby, John P. 
Moss, Casper A. 



Address 



112 Ravine Forest Dr. , Lake Bluff, 111. 
1060 Chapline St. , Wheeling, W. Va. 
Box 626, Staunton, Va. 

3839 Wilshire Blvd., Los Angeles, Calif. 

15 Champlin Place, Newport, R.I. 

R.F. D. #1, Long Hill Rd. , Millington, N.J. 

107 E. Park Place, New Orleans, La. 

20270 Woodbine Ave. , Castro Valley, Calif. 

105 W. Sycamore, Anahein, Calif. 

715 Grand St. , Alameda, Calif. 

217 Winston Rd. , Pinehurst, Portsmouth, Va. 

14925 Glastonbury Rd. , Detroit, Mich. 

525 Broadway, South Boston, Mass. 

724 Dupont Bldg. , Miami, Fla. 

1236 N. Kings Rd. , Los Angeles, Calif. 

8001 Crenshaw Blvd. , Inglewood, Calif. 

Star Route #2, Goshen Rd. , Forrington, Conn. 

440 S. Sheridan Ave. , Minneapolis, Minn. 

Veterans Home, Napa County, Calif. 

62 Andrew St, , Manhasset, N. Y. 

R. F. D. , Danvers, Mass. 

820 Prospect St. , La Jolla, Calif. 

424 Morning Canyon Rd. , Corona Del Mar, Calif. 

1012 3rd St. , S. W. , Mason City, Iowa 

86 Pilgrim Rd. , Rosslyn Farms, Carnegie, Pa. 

129 Southcote Rd. , Riverside, 111. 

15407 Dickens St. , Sherman Oaks, Calif. 

2178 Park Boundary Rd. , Louisville, Ky. 

#1 Boston St. , Guilford, Conn. 
78 Clinton St. , S. Haven, Mich. 
309 E. 7th St. , Michigan City, Ind. 
2346 43rd Ave. North, Seattle, Wash. 
69 Elm St. , Oneonta, N. Y. 
4730 A St. , Lincoln, Neb. 
166 N. Lovett Ave. , Little Silver, N.J. 
7 Bowles Lane, Glen Allen, Va. 
12 Woodland Dr., Fair Haven, N.J. 
610 Jennings Landing, Battle Creek, Mich. 
5637 Artesian Ave. , Chicago, 111. 
Box 263, Biwabik, Minn. 
125 S. 36th St. , Philadelphia, Pa. 
1135 W. Huntington Dr. , Arcadia, Calif. 



28 Medical News Letter, Vol. 27, No. 7 



Murphey, Phelps John 
Nusbaum, Samuel L. 
O'Brian, Howard F. 
Orgel, Morris 
Ostrem, Carl T. 
Pinel, Philip J. 
Reaves, Lowry D. 
Redemeyer, Hubert L. 
Restarski, Joseph S. 
Rheiner, Robert N. 
Schilling, Louis R. 
Spector, Benjamin 
Taylor, Mack 
TuUis, Everett R. 
Wallace, Newton H. 
Wallace, Curtis O. 



3702 Fairmount, Dallas, Texas 

972 Broad St. , Newark, N.J. 

517 Guelke Bldg. , Appleton, Wis. 

16 Meadowbrook Court, Freeport, N. Y. 

6119 Hickman Rd. , Des Moines, Iowa 

96 Byron Rd. , Weston, Mass. 

3450 Campbell, Dearborn, Mich. 

291 Geary St. , San Francisco, Calif. 

831 Monroe Ave. , River Forest, 111. 

21308 Haviland Ave. , Hayword, Calif. 

470 Prospect Ave. , Oradell, N.J. 

45 Goldsmith Ave. , Newark, N. J. 

2 N. Shore Terrace, Danville, 111. 

143 N. Court St. , Crown Point, Ind. 

Canton, Miss 

P.O. Box 167, Nacogdoches, Texas 



SjC 5{S 5|t 9jC 

"The Most Traveled Man" in the Naval Dental Corps 

The U. S. Naval Dental Corps Casualty Treatment Training Manikin 
has become one of the most traveled men in the Navy. Mark I, as the man- 
ikin has been called, has traveled 53, 000 miles since 1953, and has been 
one of the foremost exhibits at 34 dental and medical meetings. He has been 
viewed by over 300, 000 persons during this time. Mark I and his successor, 
the improved Mark II who has already traveled 10, 000 miles to be at four 
meetings, have been on the road almost constantly, bringing to many pro- 
fessional men the stark realism of the seriously injured person, and bringing 
to them the realization of the training they must have in event nuclear warfare 
comes to this country, 

****** 

Nava l Dental School Staff Member to Receive Alumni Award 

Captain Walter N. Gallagher, DC USN, U.S. Naval Dental School, 
National Naval Medical Center, Bethesda, Md. , has been selected by the 
Dental Alumni Association of Temple University to receive the Alumni Award 
for 1956. This award is presented annually at the Founders Day Dinner in 
May to the person voted the outstanding Dental alumnus of the year. 

Captain Gallagher is the author of two textbooks on dentistry and the 
inventor of a water -control device for dental cuspidors. 



****** 



Medical News Letter, Vol. 21, No. 7 



29 



MEDICAL RESERVE SECTIOIV 



Reservists' Training Apart from Regular Units 



Naval Reservists, officer or enlisted, whose summer residence is 
not in the vicinity of their parent unit, and other Reservists whose occupation 
requires seasonal absence from their parent unit may now be temporarily 
assigned to other drilling units when circumstances as outlined above require 
their absence from the vicinity of the parent unit. 

Subject to the applicability above and certain restrictions, outlined 
in BuPers Instruction 1300. 17A of 22 February 1956, Commanding Officers 
of Pay units are authorized to issue Temporary Additional Duty Orders 
Under Instruction to Reservists to report to the Commanding Officer of a 
Naval Reserve Training Center, Naval Air Station, or Naval Air Reserve 
Training Unit, as appropriate, near their temporary residence. These 
assignments may be made without regard to the authorized allowance of that 
unit. 

Commandants are authorized to issue similar orders to Reservists 
in Non-Pay units. A copy of this authorization shall be sent to the individual's 
"temporary" Commandant, or the Chief of Naval Air Reserve Training, as 
appropriate. 

ij: * * * # * 

New Medical Department Correspondence Course 

The Medical Department Correspondence Course, Medical Depart- 
ment Orientation, NavPers 10943 -A, is now available for distribution to 
eligible regular and Reserve officer and enlisted personnel of the Armed 
Forces Medical Department. Applications for this course should be sub- 
mitted on Form NavPers 992 (Rev 54) and forwarded via. appropriate official 
channels to the Commanding Officer, U.S. Naval Medical School, National 
Naval Medical Center, Bethesda 14, Md. 

This course, which is based upon a completely new text, surveys the 
historical background, mission, functions, and facilities of the Medical 
Department ashore and afloat. The organization and growth of the Bureau 
of Medicine and Surgery and the functions of the Medical, Dental, Medical 




30 



Medical News Letter, Vol. 27, No. 7 



Service, Nurse, and Hospital Corps are discussed. Detailed information is 
provided on the organization and services of the various medical and dental 
facilities of the Medical Department: the National Naval Medical Center, 
Naval Hospitals, hospital ships, base hospitals, dispensaries, station hos- 
pitals, supply depots, research activities, technical training, and hospitals 
(mobile, field, and permanently based) in overseas areas of operations. 
Throughout the course, the application of professional skills to naval require- 
ments is stressed. 

This course consists of two (2) objective -question type assignments 
and is evaluated at six (6) Naval Reserve promotion and non disability retire- 
ment points, and is designated as a course that may be retaken for point 
credit inasmuch as it is based upon a completely new and revised text. 

****** 
Officers' Pay Status in Non-Pay Drilling Units 

Naval Reserve non-pay units, authorized to conduct 12 or more drills 
per year, may employ the commanding officer and certain staff members in 
a pay status provided: 

(1) T unit has a membership of 15 or more persons with each 
person maintaining an individual certified attendance average 
of 60% or more per scheduled drill per fiscal quarter will 
warrant two persons in a pay status. 

(2) Each increment of 15 individuals above the minimum of 15 
with the same attendance factor will warrant one additional 
pay billet up to a total of five pay billets. 

(3) If a unit meets more than 12 times annually, as many as 10 
pay periods per unit per month may be authorized. 

(4) Personnel in a pay status may be detailed in advance by the 
commanding officer to be present at stated drills during the 
month without regard to the calendar sequence of the drills. 

(5) Pay status personnel other than the commanding officer, 
including training officers and assistant training officers, 
will be designated as, and assigned joint responsibilities of, 
staff personnel. Such staff personnel may consist of commis- 
sioned officers, warrant officers, or enlisted personnel. 



Medical News Letter, Vol. 27, No. 7 



31 



(6) It is desired that a rotation policy be instituted whereby- 
different unit members will be detailed to a pay status 
from quarter to quarter as may be found practicable so 
that as many members will receive the training and incen- 
tive incident to performance of staff duties as are qualified 
to perform those duties. Because all members of all units 
will not possess required qualifications to perform staff 
duties, the considered discretion of the commanding officer 
must be exercised in nominating members for the pay status 
pool. 

Units are identified by attendance, strength, and the resultant pay 
status of the unit; the following unit class designations are authorized by 
BuPers Instruction 72Z0.9, 8 February 1954: 



Unit 


Minimum Drill 


Pay Billets 


Monthly Pay Periods Authorized: 


Clas s 


Attendance - 


Authorized 


12 Drills 


Over 12 Drills 




Quarter Average 




Annually 


Annually 


I 


60 or more 


5 


5 


10 


II 


45 - 59 


4 


4 


8 


III 


30-44 


3 


3 


6 


IV 


15 - 29 


2 


2 


4 


V 


14 or less 













sjc 5^ -5^ 3^ 3^ 



PREVEI^TIVE MEDICmE SECTIOl^l 



Distributi on of Poliomyelitis Vaccine 

( This is the third in a series of articles designed to apprise Medical Depart- 
ment personnel of the current status of poliomyelitis vaccine to be used for 
dependents of Navy and Marine Corps personnel. The preceding articles 



32 Medical News Letter, Vol. 27, No. 7 



appeared in the Preventive Medicine Section of the 3 February and the 
2 March 1956 issues of the Medical News Letter. Additional information, 
particularly on the National Allocation Plan, will be provided in a BuMed 
Notice to all ships and stations. ) 

During the month of February, the twelfth and thirteenth allocations 
of poliomyelitis vaccine were released by the Department of Health, 
Education, and Welfare, Public Health Service. The Navy received a total 
of 23, 310 cc. of vaccine from these allocations. This vaccine was shipped 
to continental United States activities in early March. The quantities shipped 
into each naval district and the total quantities shipped prior to March 15 are 
summarized in Table I. 

Limitations on space prohibit giving details of amounts shipped to 
individual activities within each district, but an example of the distribution 
is given in Table II, which shows the quantities shipped to those activities 
designated by the Commandant of the Fifth Naval District as being responsible 
for immunizing dependents. The Fifth Naval District has the largest require- 
ment. Activities in other naval districts can easily calculate whether or not 
they are receiving their full percentage share of vaccine by comparing their 
submitted requirements, either to the total requirements of their naval dis- 
tricts or to the requirements for the continental United States as a whole. 

In Table III, the distribution of poliomyelitis vaccine allocated to the 
Department of Defense under the National Allocation Plan is shown. Most 
of the vaccine received prior to 1 January 1956 was sent to overseas activi- 
ties. The discrepancies in distribution among the Army, the Navy, and the 
Air Force in subtotal A reflect primarily the differences in the numbers of 
eligible children for whom vaccine was requested from overseas areas which 
were assigned geographic priorities in BuMed Instruction 6230. 8. 

A total of 75, 933 cc. of Navy vaccine was shipped overseas prior to 
1 January 1956. This included the 18,518 cc. of vaccine donated by the 
National Foundation for Infantile Paralysis for immunization of children in 
the first and second grades of school. The remaining total of 76,035 cc. 
(Table I) has been distributed within the continental United States. Subtotal B 
shows that the distribution among the Army, the Navy, and the Air Force 
is essentially equal, the differences being a reflection of the variation in the 
number of children in the United States for whom each of the Services is 
responsible. 

From Table III, it can be seen that all vaccine, received by the Navy 
prior to March 15, 1956, has b^en distributed to field activities and that there 
is no reserve stock in Navy supply depots. The 23, 310 cc. distributed in 
early March represented all the vaccine that had been received in the supply 
system between February 6 and March 15, 1956. The twelfth allocation was 
received in Navy supply depots on 28 February, and the thirteenth on 6 March. 



Medical News Letter, Vol. 27, No. 7 



Table I 

DISTKEBUTION OF POLIOMYELITIS VACCBJE IK CONTIHEOTJAL HAVAL DISTRICTS 





Two - Dose 


Cubic Centimeters Shigped Prior 
15 March 1956 


District 


Requirement 

in Cubic 
Centimeters 


Prior 

"1 MnT*r*Vi 


During 


Total 


First 


31,61t-2 




2 02s 


6,615 


Third 


12,462 


l,Bl8 


792 


2,610 


Fourth 


12,612 


2,070 


819 


2,889 


SRKC 


2,0i^6 


369 


162 


531 


PriNC 




3,402 


1,494 


4,896 


Fifth 


103^300 


15,057 


6,642 


21,699 


Sixth 


47,292 


6,813 


3,033 


9,846 


Eighth 


13,552 


1,854 


1,008 


2,862 


Kinth 


20,134 


3,042 


1,305 


4,347 


Eleventh 


64,342 


9,351 


4,122 


13,473 


Twelfth ' 


18,188 


2,658 


1,161 


3,819 


Thirteenth 


11, 336 


1,701 


747 


2,448 


Total 


359.306* 


52,725 


23,310 


76,035 



* Latest revisions included. 



34 



Medical News Letter, Vol. 27, No. 7 



Table II 

DISTRIBUTIOW OF POLIOMYELITIS VACCINE IM FIFTH MVAL DISTRICT 



Activity 


Children 


Cubic 


Centimeters of Vaccine 








Shipped 1 






No. 


f 


First 


Second 


Third 




MAC* "KJ 1— tr.-. 


LO.OOO 


IQ ^6 


1,170 


1,719 


1,296 




U* TVli*lOr» * PITS /t 

MaRCORBASEj Camp 












L0,000 


IQ 16 

-i-;7 • 


1,170 


1,719 


1,296 


4 1 fit; 


WAKUOHaliSTa, Cherry 










Point, N. C 


7 . 500 




873 


1,287 


963 


J, J-iij 


mS, Oceana; Virginia 














Y,000 


13. 55 


810 


1,197 


900 




NavAmphibBase , Little 














6,000 


11.63 


693 


1,026 


774 


2,493 


NavHospj Portsmouth^ Va. 


l)-,000 


7 . 74 


468 


684 


513 


1 665 


FltAirDefTrs^Ien, Dam 










Keck, Virginia Beach, 
















3,000 


5.82 


34s 


513 


387 


1 ?4p 


ISavKosp, Bainbridge ,Md . 


1,200 


2.32 


135 


207 


153 


495 


KavAirata, Chincoteague , 














■700 


1.36 


81 


126 




297 


WavMineDepot ^ 














600 


1.16 


72 


108 


72 


252 


NavAirFae , Weeksville , 












600 


1.16 


72 


108 


72 


252 


Air Force Staff College j 












IScrfolk, Va 


500 


0.97 


63 


90 


72 


225 


WavKeCkStaj Baltiniore,Md, 


i4o 


0.27 


27 


27 


18 


72 


WavOrdPlant , Loui s ville - 












Ky ' 


125 


0.24 


27 


27 


18 


72 


NavOrdPlantj South 












Charleston, W. Va 


100 


0.16 


27 


18 


18 


63 


NavRecCen J Ashland, Ky.. 


70 


o.i4 


63 






63 


NavEesTraCen, Roanoke, 














50 


0.10 


45 






45 


NavResTraCen, 














ko 


0.08 


36 






36 


MavResTraCen, 














23 


0.05 


27 






27 


TOML 


51,650 


100.00 


6,201 


8,856 


6,642 


21,699 



1; 



Medical News Letter, Vol. 27, No. 7 



35 



The fourteenth and fifteenth allocations have been made, but will 
not be received in the supply system until late March. The Navy's share 
of these two allocations amounts to only 9099 cc. for distribution to United 
States activities and 1422 cc. for overseas distribution. Unless other larger 
allocations are made within a short interval, the amount available for distribu- 
tion to individual activities in early April will be considerably less than the 
amounts shipped in early March. Advance information cannot be obtained on 
quantities of vaccine to be released for allocation, and, as of this writing, 
no prediction can be made as to whether such an additional allocation may 
be made. 

At present, nearly all dependent children aged 6 months through 15 
years of Navy and Marine Corps personnel located overseas, who desired 
vaccine, have been supplied. This has been possible because most Navy and 
Marine Corps personnel with dependents overseas are located in areas which 
are assigned geographic priorities. The Army and the Air Force have many 
personnel with dependents located in England and Europe which were not 
assigned priorities, so that a portion of each allocation to the Department of 
Defense must still be diverted to take care of these dependents. This is done 
before the remainder of the allocation is subdivided among the three Services 
on a fixed percentage basis with the Navy receiving 33. 9% of this remainder. 

Vaccine distributed in the continental United States has thus far been 
sufficient for only 42. 3% of the one -dose requirements submitted. However, 
this does not mean that only 42. 3% of all dependent children in the eligible 
age range have had one dose, because an unknown number have been immiuiized 
with one or more doses in the National Foundation for Infantile Paralysis prog- 
ram and in various other programs carried out in civilian communities. 

A total of 36,245,000 cc. of poliomyelitis vaccine has been released 
to date by the Public Health Service for all purposes, including the more than 
13, 000, 000 cc. distributed by the National Foundation for Infantile Paralysis. 
This amount of vaccine would provide one dose for about 75% of all children 
from birth through 14 years had it all been used for that purpose. Because 
much of the vaccine has been used in two-dose programs (some children have 
had three doses and some vaccine has been used in pregnant women), it is 
estimated that less than 50% of the children in the above age group, nationwide, 
have had vaccine from any source. 

The quantity of vaccine that has been released for intrastate allocation, 
from which the Navy's allocation comes, totals 21,955,000 cc. This includes 
the fourteenth and fifteenth allocations. 

These data indicate that the Navy's supply of vaccine has paralleled 
that available to the other branches of the Armed Forces and to civilian 
children throughout the United States and its Territories. Because of differ- 
ences in distribution and demand, it may appear in some areas that more 
vaccine is reaching civilian channels than is available to the Armed Forces, 
but this is manifestly not true for the country as a whole. 



36 



Medical News Letter, Vol. 27, No. 7 



Table 111 

DISTKEBUTION OF POLIOMYELITIS VACCINE ALLOCATED TO THE DEPAREMENT OF 



DEFENSE, August 1955 - March 1956, 



Allocation 


Total 

in 
Cubic 

Centi- 
meters 


Cubic Centimeters Distributed To 


Ho. 


Date 


Array 


Navy 


Air 
Force 


Dept. 
State 


Public 
Health 
Service 


1 
2 

3 

k 

5 

6 

7 
8 

9 


1955 
Aug 10 
Aug 20 
Aug 31 
Sep 15 
Oct 3 
Oct 19 
Nov 17 
Dec 8 
Dec 15 


28,866 
2l|-,066 
76,716 
41,292 
^^5,756 
15,534 
43,833 
27,918 
25,488 


ID, ODD 

24,066 
30,840 

12,510 

13,755 

8,460 
8,721 


0,192 

16,494 
XX , U*rX 
28,350 

16,101 
2,790 

8,640 


5,000 
29,382 

17,406 
3,024 

8,037 
10,728 

8,127 




— 

5,940 
5,9^+0 




329,469 


121,268 


90,208 


103,U3 


3,000 


11,880 


10 

11 

12 

13 


1956 

Jan 3 
Jan 9 
Jan 30 
Feb ik 


33,588 
26,217 
51,084 
22,878 


11,150 

8,973 
20,808 

5,607 


11,043 

8,883 
l4,4l5 
8,901 


10,395 
8,361 

12,861 
8,370 


1,000 
3,000 






133,767 


46,538 


43,242 


39,987 


4,000 






463,236 


167,806 


133,450 


143,100 


7,000 


11,880 



Medical News Letter, Vol. 27, No. 7 



37 



There is a strong possibility that the supply of vaccine will prove 
insufficient to immunize all children in the priority age range prior to the 
beginning of the "poliomyelitis season" this year when the demands are ex- 
pected to increase considerably. For this reason, it behooves all medical 
officers to learn the facts concerning procurement and distribution of vaccine 
and to exercise the greatest tact and courtesy in replying to the questions of 
anxious parents about vaccine for their children. Proper psychological prep- 
aration of dependents for this eventuality will probably save many headaches 
during the summer and fall months. 

Concern has been expressed by many about the inadequate supply of 
vaccine for the administration of second doses at the end of the prescribed 
interval of 2 - 4 weeks. Evidence has been published indicating that the first 
dose provided a high degree of protection for children against paralytic polio- 
myelitis last summer. No harm is done if there is a long interval between 
the first and second doses. In fact, if an interval of about 6 months elapses, 
it is quite possible that the second dose will provide the "booster effect" now 
sought in the delayed third dose and that the third dose could be dispensed 
with altogether. From a strictly immunological standpoint, the delaying of 
the second dose until a time nearer to the onset of the poliomyelitie season 
may provide distinct advantages over the administration of the second dose 
at the present time. 

3jc 4: :{c 

Carbon Monoxide from Gasoline P owered 
Industrial Equipment 

Numerous complaints concerning excessive fumes are received each 
fall from employees as signed to buildings in which gasoline power ed industrial 
equipment is operated. Employees, especially those in supply department 
warehouses, are reluctant after the weather becomes colder to maintain 
sufficient natural ventilation through windows and doors. The potential 
dangers from fumes generated by internal combustion engines and the nec- 
essity for constant vigilance, if disastrous results are to be avoided, have 
been pointed out. Recommendations in the past have included the following: 

(1) Insure by frequent checks that all equipment is in good 
mechanical condition and that motors are properly tuned up. 

' A motor that is burning oil produces not only excessive 

amounts of carbon monoxide, but also acrolein, a compound 
that is irritating to the eyes and respiratory system. 

(2) Stop motors at all times, even for short periods, when equip- 
ment is not in use. 



18 



Medical News Letter, Vol. 27, No. 7 



(3) Drive motor carefully; do not race or gxm the motor; do 
not slip the clutch. 

(4) Do not operate in one passageway or in an isolated or 
close spot for long periods of time. Arrange work, so far 

as possible, to facilitate operation in alternated passageways. 

(5) Take advantage of natural ventilation by opening doors and 
windows to the maximum possible extent consistent with 
weather conditions. It is believed that efforts are made to 
keep buildings warmer than necessary by closing all ven- 
tilation spaces. 

(6) The number of fork lifts operating in any section or building 
at any one time should not exceed the minimum required to 
accomplish the work to be done. 

(7) Always warm up motors in a well ventilated space. A cold 
motor produces more carbon monoxide. 

(8) Consideration should be given, where feasible, to substituting 
electrically driven equipment on a long range program basis. 

(Industrial Health Data Sheet (NavMed 576 - Revised 1953) U.S. Naval Air 
Station, Norfolk, Va. , October 1955) 

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R efrig eration of Leftover Foods 

Two special epidemiology reports from naval activities, one from 
North Carolina, the other from California, were recently received in the 
Bureau of Medicine and Surgery. Both reports described food -poisoning 
outbreaks which occurred during February 1956. Both outbreaks were the 
direct outcome of the violation of basic food sanitation principles. 

The incident at the California activity obviously resulted from the 
use on the noon "seconds" serving line of veal fricassee which had been left 
from the preceding evening meal and had been inadequately refrigerated during 
the interval between the two meals. Preservation of the leftover veal was 
attempted by transferring it into a 20 -gallon stock pot to an estimated depth 
exceeding 18 inches. The stock pot was then placed in a refrigerator. Under 
these circumstances, it would be surprising if veal near the center of the pot 
had cooled much below room temperature within the approximate 18 hours of 
refrigeration. 



Medical News Letter, Vol. 27, No. 7 



39 



The outbreak in North Carolina occurred when leftover spaghetti 
and meat balls from a noon meal were offered again on the following day 
at noon. This time, two 15 -gallon stock pots contained the leftovers during 
the 24 -hour holding period. 

The Bureau of Supplies and Accoxints Manual, Volume IV, paragraph 
41657 (1) (b), specifies: "When leftover or warm foods are to be chilled, 
care must be taken to assure prompt and thorough chilling of the food mass. 
Foods that are to be refrigerated must be placed in shallow pans to a depth 
of not more than 3 inches. Such food should not be put in large deep 
pans as chilling may take so long to get to the center of the food mass that 
sufficient time is allowed for growth of harmful bacteria and the development 
of a toxin. " 

Containers or pans for refrigerating moist unpackaged foods should 
be constructed of a corrosion-resistant material similar to stainless steel. 
Either they should be free of seams, or, if seams are necessary, the two 
or more metal edges should be joined in such a manner that the finished 
seam is completely closed and smooth. The pan should not exceed .4 inches 
in depth and should be provided with readily removable covers which have 
turned down edges to prevent condensation thereon from entering the food 
containers. 

9(: ;{( # 3|( :^ 

Special Assistant for Sanitation - 
District Public Works Offices 

BuDocks Instruction 5450.19 and enclosure (1) thereto explain in 
detail the authority and responsibility of the District Public Works Officer 
relative to sanitary engineering matters and outline the duties and respon- 
sibilities of the Special Assistant for Sanitation, (Code DD-110), through 
whom the District Public Works Officer will exercise control of the sariitafy 
engineering matters within the District. 

Medical officers and Medical Department representatives respon- 
sible for sanitation at naval activities should familiarize themselves Mth 
the above instruction. It summarizes minimum control procedures for 
successful operation and maintenance of sanitary facilities. Such control 
procedures include the minimum residual chlorine sampling and bacterio- 
logical analyses of potable water supplies and sewage effluent. 

The printing of this publication has been approved by the Director 
of the Bureau of the Budget, 16 May 1955. 



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40 



Medical News Letter, Vol. 27, No. 7 
Two -Months Course in Occupational Medicine 



Information has been received from Professor Norton Nelson, 
Chairman, Institute of Industrial Medicine, New York University - Bellevue 
Medical Center, that a two-months course in Occupational Medicine will be 
given beginning September 10, 1956. 

This is the second year that this short course in Occupational Med- 
icine has been offered. This year, increased emphasis will be placed on 
preventive medicine and epidemiology in view of the interest of many medical 
officers in taking the examination for certification by the Specialty Board in 
Occupational Medicine. 

Naval occupational medical officers desiring to attend subject course 
should make application to the Chief, Bureau of Medicine and Surgery, for 
this training well in advance. 



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